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Hospice care in the U.S. has steadily grown over the past 12 years. This end of life care, in which beneficiaries opt out of curative treatment to instead receive palliative care in the final stages of a terminal illness, costs Medicare billions. In fact, Medicare spending went up from $9.2 billion in 2006 to $16.7 billion in 2016 to accommodate the 1.4 million beneficiaries that hospice care serves.

Despite the increased spending to aid terminally ill patients, a report conducted by the Office of Inspector General (OIG) found that oftentimes, a poor level of care is provided, and necessary services are neglected. Additionally, the OIG uncovered fraudulent charges, including instances where hospices charged Medicare for services they never actually provided.

In particular, the report cited poor quality care, lack of information to beneficiaries and their families, inappropriate billing and insufficient services as four main areas in which hospices can improve.

Pressure sores, also referred to as bedsores, pressure ulcers or decubitus ulcers, are perhaps one of the most common evidences we see of nursing home abuse and neglect. Unfortunately, most elderly people are already predisposed to pressure sores due to lack of mobility and thin, fine skin.

When placed in a short-staffed long-term care facility that doesn’t have the proper resources to reposition an individual at least every two hours, bedsores are bound to develop. In fact, pressure sores can begin to form after a mere few hours of non-movement. In certain cases, if the wounds are left untreated, they may be lethal.

Bedsores most often develop in areas where the skin faces continuous pressure from being in contact with a bed or wheelchair. When an area on someone’s body is pressed against a bed without movement for an extended period of time, oxygen and blood flow to that part of the body are reduced. As cells lose oxygen, they begin to die, and as a result, the surrounding skin begins to die as well.

Nursing home evictions are all too common, and oftentimes, they have traumatic effects on residents and their family members. According to the Department of Health and Human Services, in 2015 alone, 9,192 complaints out of 140,145 total complaints were regarding discharges and evictions.

Some believe the problem is much larger than what the 9,192 complaints suggest, as many residents face eviction or early discharge without putting up a fight. Ombudsman agencies told The New York Times that out of everything, eviction-related complaints are the most voluminous category of criticisms received by state long-term care ombudsman programs.

If evictions tend to potentially magnify health problems a resident is already facing by creating additional stress and trauma, why such a high rate of discharge?

A new study in the Journal of the American Medical Directors Association, and later reported by the New York Times, indicates that some nursing homes may have found a lucrative new way to make money, through collecting extra funds from Medicare by providing excessive rehabilitation services to patients in their final weeks and days of life.

If this is the case, at least two major concerns are raised: Patients who need hospice and palliative care in their final days are not receiving it, but are rather receiving physical, occupational or speech therapy, and patients in need of rehabilitation services are potentially not receiving the appropriate level of care either, as the influx of rehabilitation patients crowds out therapists’ availability to help those in true need of their services.

The study, which was led by several professors at the University of Rochester Medical Center, found the trend to be more widespread in for-profit, rather than nonprofit, nursing homes.

If you or someone you know is faced with the challenging task of finding a long-term care facility for a loved one, at times it can be difficult to know where to begin. Several websites have been designed so consumers can assess how individual facilities stack up.

Nursing Home Compare

Nursing Home Compare, run by the Centers for Medicare & Medicaid Services, is perhaps one of the most well-known resources that rates care facilities by providing a star-ranking system. Through the website, up to three nursing homes can be compared side-by-side regarding overall rating, general information, health inspections, fire safety inspections, staffing, quality of resident care and penalties.

Under the Affordable Care Act of 2010, over 14,000 nursing homes were recently required to start providing payroll records to the government, which serve as indicators of staffing levels. Kaiser Health News analyzed the records and found that most nursing homes are operating at consistently understaffed levels, and some facilities even falsely reported having more staff on hand than they actually did.

Apart from across the board understaffing, the study discovered that on weekends, nursing homes see an even larger deficit in adequate staffing than during the week. At worst, a nurse or aide may be required to care for twice as many patients as he or she would on a day with more personnel.

Throughout the week, when staffing levels are typically at their highest, most aides were found to be responsible for anywhere from nine to 14 residents. On the weekend, that number goes up, as nursing staff drops roughly 11 percent on average, and aide staff drops roughly 8 percent.

Anyone, including employees, residents or loved ones, has the right to file a complaint against a licensed long-term care facility in the state of Tennessee if any concerns in proper elder care arise. Unfortunately, many people do not know that this is an option, and the abuse or neglect suffered by a loved one goes unreported.

If you or someone you know has experienced substandard care in a nursing home, filing a complaint with the Tennessee Department of Health can be a proactive step that will prompt an investigation.

What Situations Can Be Reported?

Last year, Jehl Law Group represented the family of a nursing home resident, who was neglected so badly that she developed pressure sores on her foot that were bone-deep. The condition of her foot was ignored. Eventually, the wounds became infected with multiple bugs that are found in fecal matter, and her leg had to be amputated. She passed away two months later.

The nursing home, its owners, and their attorneys were responsible for multiple continuances of the trial, but after years, our clients finally got their day in court. Following a five-week trial where nursing home employees testified to chronic short-staffing and fraudulent record-keeping, a jury of twelve people from Shelby County awarded our clients approximately $2,000,000 for their mother’s injuries, pain, and suffering. The jury also determined that the nursing home and its owners had acted so badly that they needed to be punished to prevent them from behaving like this again. After seeing how much money the owners made each year from their terrible behavior, the jury awarded a $28,000,000 punitive damage award designed to deter the nursing home and its owners from ever doing this again.

Our clients’ mother suffered horrific injuries because of the behavior of the defendants.  A jury determined that she had suffered immense amounts of pain and that the nursing home and its owners deserved to be punished for their behavior. Even the judge, who heard all the proof, found that the jury’s decision to punish the nursing home and its owners should stand. However, if members of the House have their way, our clients would have only recovered approximately $300,000.

This past March, Signature HealthCARE at St. Francis, located at 6007 Park Ave. in Memphis, TN, which is not affiliated with the hospital but is on the same campus, proved to be yet another disturbing example of a nursing home’s consistent failure to provide its patients with an acceptable level of care.  An “acceptable level of care” is the minimum amount of care all nursing homes are required to provide patients in exchange for receiving state and federal funds.

Signature HealthCARE at St. Francis has had a history of inspection failures and delivering substandard care to its residents. In order to continue receiving government funds, the nursing home not only paid out $1.2 million in fines in 2015 but also agreed to correct its numerous areas of non-compliance. The facility failed to live up to its end of the bargain. Consequently, the Centers for Medicare and Medicaid Services (CMS) terminated their contract with Signature HealthCARE at St Francis on March 8^th, 2017. By April 25^th only 9 of the 140 patients remained.

Signature HealthCARE at Saint Francis ratings from medicare.gov are below: